Costa Rogério A, Navajas Eduardo V, Farah Michel E, Calucci Daniela, Cardillo Jose A, Scott Ingrid U
UDAT-Retina Diagnostic and Treatment Division, Hospital de Olhos Araraquara, Rua Itália 1905, Apto 74, Araraquara, SP 14801-350, Brazil.
Prog Retin Eye Res. 2005 Sep;24(5):560-86. doi: 10.1016/j.preteyeres.2005.01.001. Epub 2005 Apr 18.
Macular exudative manifestations secondary to choroidal neovascular lesions remain the leading cause of definitive visual impairment and legal blindness in the elderly. During the past decade, advances in ophthalmic imaging systems have enabled the recognition of presumed new distinct choroidal neovascular lesions that share some unique clinical and angiographic peculiarities as well as better comprehension of the pathophysiologic mechanisms related to such entities. Amongst presumed newer exudative maculopathies, polypoidal choroidal vasculopathy, which has been described as a distinct choroidal abnormality characterized by inner choroidal vascular network of vessels ending in polyp-like structures only identified on indocyanine green angiography and mostly affecting African-American and Asian descendents, has gained special interest from the ophthalmic community particularly because of its growing recognition among patients with clinical appearance of neovascular age-related macular degeneration. Thus far, however, the exact nature of the vascular structure of the polypoidal choroidal vasculopathy lesion remains unclear and data from recent studies have conflicted with the initial concept of a benign exudative maculopathy with long-term preservation of good vision. All together, such factors make difficult the establishment of an appropriate treatment, if any, for the entity. Herein, by using a modified technique of conventional indocyanine green angiography, we demonstrate new information about the morphologic characteristics, and to some extent the blood flow dynamics perfusion, of the polypoidal choroidal vasculopathy lesion. Our results suggest that the PCV lesion should be considered a variety of choroidal neovascularization rather than a distinct clinical entity, characterized by one single large neovascular complex presenting well-defined arterial neovascular vessels arising from one major "ingrowth site" and draining vessels that present aneurysm-like dilations corresponding to the polyp-like structures typically described for the entity. Finally, the visual acuity and angiographic findings observed after selective ingrowth site photothrombosis corroborate the existence of one major "ingrowth site" for the PCV neovascular complex and point toward a new treatment paradigm for this variety of choroidal neovascularization.
脉络膜新生血管病变继发的黄斑渗出性表现仍然是老年人永久性视力损害和法定失明的主要原因。在过去十年中，眼科成像系统的进步使得人们能够识别出一些推测为新的、独特的脉络膜新生血管病变，这些病变具有一些独特的临床和血管造影特征，同时也让人们对与此类病变相关的病理生理机制有了更好的理解。在推测的较新渗出性黄斑病变中，息肉样脉络膜血管病变被描述为一种独特的脉络膜异常，其特征是脉络膜内层血管网络以息肉样结构终止，这些结构仅在吲哚菁绿血管造影中才能识别，且主要影响非裔美国人和亚洲后裔。该病变引起了眼科界的特别关注，尤其是因为在具有新生血管性年龄相关性黄斑变性临床表现的患者中，其被识别的情况越来越多。然而，到目前为止，息肉样脉络膜血管病变病变的血管结构的确切性质仍不清楚，最近的研究数据与最初认为的良性渗出性黄斑病变且长期保持良好视力的概念相矛盾。所有这些因素使得为该病变确定合适的治疗方法（如果有的话）变得困难。在此，我们通过使用改良的传统吲哚菁绿血管造影技术，展示了有关息肉样脉络膜血管病变病变形态特征以及在一定程度上血流动力学灌注的新信息。我们的结果表明，息肉样脉络膜血管病变病变应被视为脉络膜新生血管的一种类型，而不是一个独特的临床实体，其特征是一个单一的大型新生血管复合体，呈现出从一个主要“内生长部位”发出的明确的动脉新生血管以及与该病变通常描述的息肉样结构相对应的呈动脉瘤样扩张的引流血管。最后，选择性内生长部位光凝后观察到的视力和血管造影结果证实了息肉样脉络膜血管病变新生血管复合体存在一个主要“内生长部位”，并指向了针对这种脉络膜新生血管类型的新治疗模式。
